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28 sty 2022 · Workers' Compensation. Please visit the Downloads Main Menu to view information about the file formats used and where to download the applications needed to view these formats. LWC-WC 1000 - This Workers' Compensation page provides an annual report of Workers' Compensation costs.
- PLEASE PRINT OR TYPE SECTION 1. IDENTIFYING INFORMATION - LAWorks
LWC FORM 1010 - REQUEST OF AUTHORIZATION/CARRIER OR SELF...
- PLEASE PRINT OR TYPE SECTION 1. IDENTIFYING INFORMATION - LAWorks
17 wrz 2024 · Downloads (Publications, Forms, Posters, etc.) Much of the content on the following pages may require a third-party application to view. Content is presented in the Portable Document Format (PDF), and various Microsoft® Office (Word, Excel®, PowerPoint®, etc.) formats.
LWC FORM 1010 - REQUEST OF AUTHORIZATION/CARRIER OR SELF INSURED EMPLOYER RESPONSE P A T I E N T Last Name: First: Middle: Street Address, City, State, Zip: PLEASE PRINT OR TYPE Last 4 Digits of Social Security Number: Date of Birth: Phone Number: Date of Injury: INFORMATION REQUIRED BY RULE TO BE INCLUDED WITH REQUEST FOR AUTHORIZATION - To Be ...
28 sty 2022 · This page provides a complete list of downloadable content from the Louisiana Workforce Commission.
7 kwi 2014 · Employer Certificate of Compliance - LWC-WC-1025.ER or Employer Certificate of Compliance should be submitted with the first report of injury. Click here to download this form. (PDF) This Workers' Compensation page provides instructions for completing the Employer Report of Injury/Illness form.
This library of workers' compensation claims forms gives injured workers easy access to the most up-to-date forms they will need.
EMPLOYEE'S QUARTERLY REPORT OF EARNINGS. You must submit this Report to your workers' compensation insurer within 14 days. Your workers' compensation benefits may be suspended if you do not timely submit this Report.
